One of the most confounding issues senior leaders face today is the weightiness of critical decisions, e.g., decisions about strategy, transformation, mergers, acquisitions, innovating a business model, short-term vs long-term gains. Decisions that have the potential to impact just about everyone inside, and, often outside the organization. No senior leader I know makes these decisions alone, without input and without dialog with their trusted teams/advisors. This impacts all leaders in all industries, but nowhere do I see the angst more than in the healthcare industry.

Why is this especially true for healthcare?

First, healthcare organizations (especially non-profits) have traditionally been more democratic institutions, with a large number of stakeholder groups, including physicians, nurses, allied professionals, and numerous administrators across different specialties, and different healthcare facilities. While these stakeholder groups may sometimes disagree about the amount of influence they actually have, most healthcare leaders do spend a lot of time socializing and getting input from their stakeholders.

Second, the stakes are high. In most of our organizations, “poor” decisions are inconvenient, time-wasting, expensive, and may cost jobs – which is bad enough. But in healthcare, “poor decisions” also have real life-or-death consequences.

Two further complexities arise for leaders when it comes to these critical decisions. The first is that these decisions come with NO easy answers. Regardless of which option is chosen, some will win, and some will lose. Some will understand the complexity of balancing multiple stakeholders, but frankly, some simply do not see the whole picture. In addition, professionals with different backgrounds and perspectives will disagree. All are potentially right, and all are potentially wrong, depending on one’s lens and values. And many teams spend inordinate amounts of time trying to convince others that THEY are right!

The second complexity is that these decisions reflect the multiple polarities that leaders must manage. A polarity is a state in which two or more ideas, opinions, etc., are completely opposite, or quite different from each other. For example, in healthcare, organizations must manage to the “triple” or “quadruple” aim (improving the individual experience of care; improving the health of populations; reducing the per capita cost of healthcare; and improving the experience of delivering care). What improves 1 or 2 of these goals, could cannibalize others to some extent. And, what benefits one stakeholder group (patients, for example) will likely hurt another (insurers, or providers).

Another polarity is about speed of decisions. As the African proverb goes “If you want to go quickly, go alone. If you want to go far, go with others.” COVID-19 provided a crisis situation in which smaller groups of leaders needed to go quickly – making critical decisions about staffing, facilities, and processes – all in short periods of time. And the result? Most healthcare providers were able to make these decisions quickly and agilely, knowing that what was true one day, might – and often did – change the next. Fewer individuals were consulted than usual, which allowed for faster decisions than usual. My clients reported that this was eye-opening. They got things up and running and done far faster than any other past change of this magnitude.

While the immediate crisis may be over, there remains multiple challenges ahead. COVID did not cause these, but did exacerbate them. Healthcare organizations must adapt strategies, change processes, redeploy resources, and/or redesign business models if they are to survive. The decisions they now face have a slightly longer time horizon than COVID responses, but they cannot wait months/years to be made.

So, where does that leave healthcare? In a nutshell, I am seeing that the urgency and complexity of decisions is well known and accepted. Some are wanting to lean toward the COVID response – fewer individuals with critical expertise making more decisions with less vetting. Others are balking at this, wanting to “return” to the decision-making processes of the past.

I have two pieces of advice:

  1. Don’t go back to endless consultation and dialog. Be clear which stakeholders get to Discuss, Decide and/or Act. Be sure that leaders communicate the specific process and steps in decision making – widely and often. As you get questions and criticism (and you will), don’t ignore them believing others will eventually get it and get on board. Have several individuals who possess patience, open-mindedness, and empathy – as well as knowledge – who can identify the question behind the question and understand the pain points expressed. Turn to people who listen FIRST, assure they understand the issues in play, and then present alternative viewpoints that do not make the other person wrong, but simply less informed about all the issues. If someone doesn’t agree with or understand you, telling them again why you are right, and they are wrong is simply an exercise in frustration. Don’t do it, it doesn’t work!
  2. Cultivate real processes of dialog – at the right time and place – among your senior team members, where many of these decisions will land eventually. Debate about the rightness/wrongness of options has its place, but it doesn’t always lead to understanding or buy-in. It often results in meetings where the loudest, most forceful/stubborn leader believes they have convinced people – but they haven’t. When some people stop talking, it may look like agreement to the person who has the last word, but it is often a tactic of listeners to just stop a useless fight.

The competencies imbedded in these pieces of advice require advanced (“graduate level”) micro-skills in communication, dialog, and listening. Not every leader can do this as well as others. This talent is one you MUST have on your leadership team and assure they have the “role” and time to do it. I’d be glad to talk with you about how to spot this talent, as well as deploy it! Just send me an email.

You Worked Hard To Reach The Top

You Worked Hard To Reach The Top

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